Spine Journal最新文献

{"title":"Timeline of curve progression around menarche in small adolescent idiopathic scoliosis curves without influence of braces: a single-center longitudinal cohort study of 1,090 patients.","authors":"Yosuke Ogata, Toshiaki Kotani, Tomoyuki Asada, Shuhei Ohyama, Shun Okuwaki, Yasushi Iijima, Tsuyoshi Sakuma, Seiji Ohtori, Masashi Yamazaki","doi":"10.1016/j.spinee.2025.01.022","DOIUrl":"10.1016/j.spinee.2025.01.022","url":null,"abstract":"<p><strong>Background context: </strong>Menarche is widely recognized as one of the prognostic factors for curve progression in patients with adolescent idiopathic scoliosis (AIS). However, few studies focus on the relationship between small AIS curves without brace treatment and menarche, presenting a challenge to building further evidence.</p><p><strong>Purpose: </strong>This study aims to investigate the chronological changes in curve progression and risk of final brace initiation around menarche in small AIS curves under 25°.</p><p><strong>Study design: </strong>This was a retrospective cohort study.</p><p><strong>Patient sample: </strong>We longitudinally examined 1,090 AIS patients with a curve of less than 25° at the initial visit.</p><p><strong>Outcome measures: </strong>Patients were followed up until they achieved skeletal maturity or initiated brace treatment.</p><p><strong>Methods: </strong>Curve progression based on time from menarche was analyzed using a t-test. Receiver operating characteristic curve analysis was performed based on the time from menarche, with curve magnitude as the independent variable and the final initiation of brace treatment as the dependent variable.</p><p><strong>Results: </strong>Overall, 1,090 female patients were included, with a mean initial visit age of 12.9 years (standard deviation [SD]: 1.5) and a mean coronal Cobb angle of 17.5° (SD: 4.3). Curve progression was significantly decreased between 0-1 and 1-2 years post-menarche (0-1 year post-menarche: 2.9°/year vs. 1-2 years post-menarche: 1.3°/year; p=.03). After 2 years from menarche, the mean curve progression was less than 0.4°/year. The cut-off value of the curve magnitude for the final initiation of brace treatment at the timing of menarche was 20.5° (area under the curve: 0.89, p<.001, 95% confidence interval: 0.86-0.91).</p><p><strong>Conclusions: </strong>This study highlights that in small AIS curves under 25°, minimal curve progression was observed after 2 years post-menarche, aiding follow-up strategies for AIS conservative treatment.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of twelve existing survival prediction models for patients with spinal metastases.","authors":"B J J Bindels, R H Kuijten, O Q Groot, E H Huele, R Gal, M C H de Groot, J M van der Velden, D Delawi, J H Schwab, H M Verkooijen, J J Verlaan, D Tobert, J P H J Rutges","doi":"10.1016/j.spinee.2025.01.014","DOIUrl":"10.1016/j.spinee.2025.01.014","url":null,"abstract":"<p><strong>Background context: </strong>Survival prediction models for patients with spinal metastases may inform patients and clinicians in shared decision-making.</p><p><strong>Purpose: </strong>To externally validate all existing survival prediction models for patients with spinal metastases.</p><p><strong>Design: </strong>Prospective cohort study using retrospective data.</p><p><strong>Patient sample: </strong>953 patients.</p><p><strong>Outcome measures: </strong>Survival in months, area under the curve (AUC), and calibration intercept and slope.</p><p><strong>Method: </strong>This study included patients with spinal metastases referred to a single tertiary referral center between 2016 and 2021. Twelve models for predicting 3, 6, and 12-month survival were externally validated Bollen, Mizumoto, Modified Bauer, New England Spinal Metastasis Score, Original Bauer, Oswestry Spinal Risk Index (OSRI), PathFx, Revised Katagiri, Revised Tokuhashi, Skeletal Oncology Research Group Machine Learning Algorithm (SORG-MLA), Tomita, and Van der Linden. Discrimination was assessed using (AUC) and calibration using the intercept and slope. Calibration was considered appropriate if calibration measures were close to their ideal values with narrow confidence intervals.</p><p><strong>Results: </strong>In total, 953 patients were included. Survival was 76.4% at 3 months (728/953), 62.2% at 6 months (593/953), and 50.3% at 12 months (479/953). Revised Katagiri yielded AUCs of 0.79 (95% CI, 0.76-0.82) to 0.81 (95% CI, 0.79-0.84), Bollen yielded AUCs of 0.76 (95% CI, 0.73-0.80) to 0.77 (95% CI, 0.75-0.80), and OSRI yielded AUCs of 0.75 (95% CI, 0.72-0.78) to 0.77 (95% CI, 0.74-0.79). The other 9 prediction models yielded AUCs ranging from 0.59 (95% CI, 0.55-0.63) to 0.76 (95% CI, 0.74-0.79). None of the twelve models yielded appropriate calibration.</p><p><strong>Conclusions: </strong>Twelve survival prediction models for patients with spinal metastases yielded poor to fair discrimination and poor calibration. Survival prediction models may inform decision-making in patients with spinal metastases, provided that recalibration using recent patient data is performed.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits of early recovery after surgery (ERAS) protocols on perioperative outcomes in patients undergoing elective lumbar spinal fusion: a prospective study.","authors":"Yu-Cheng Yao, Jing-Yang Liou, Hsin-Yi Wang, Po-Hsin Chou, Hsi-Hsien Lin, Shi-Tien Wang","doi":"10.1016/j.spinee.2025.01.023","DOIUrl":"10.1016/j.spinee.2025.01.023","url":null,"abstract":"<p><strong>Background context: </strong>Enhanced Recovery After Surgery (ERAS) protocols have been shown to accelerate patient recovery across various surgical fields. There are growing reports of the benefits of ERAS for lumbar fusion, but the majority rely on retrospective analysis.</p><p><strong>Purpose: </strong>This study aimed to prospectively assess the impact of an ERAS protocol on perioperative outcomes in patients undergoing lumbar spinal fusion.</p><p><strong>Study design/setting: </strong>Prospective comparative cohort study conducted at a tertiary medical center in Taipei, Taiwan, between November 2020 and May 2023.</p><p><strong>Patient sample: </strong>The study included 242 patients undergoing lumbar spinal fusion for degenerative spinal conditions divided into ERAS and non-ERAS groups.</p><p><strong>Outcome measures: </strong>Main outcomes measured included operative duration, estimated blood loss (EBL), postoperative nausea and vomiting (PONV), analgesic use, and visual analog scale (VAS) pain score.</p><p><strong>Methods: </strong>Propensity score matching (PSM) was used to minimize confounders between the 2 groups. Differences between the 2 groups were assessed using the 2-sample independent t-test or nonparametric Mann-Whitney U test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>The ERAS group had significantly shorter operative time (202±68 min vs. 255±85 min) and EBL (480±302 ml vs. 641±387 ml) compared to the non-ERAS group. The ERAS group had significantly less total morphine-sulfate-equivalent (MSE) consumption (27±24 mg vs. 42±42 mg) and used patient-controlled analgesia (PCA) (97% vs. 41%) more frequently compared to the non-ERAS group. Notably, the ERAS group had a shorter time to ambulation and shorter time to removal of Foley catheters.</p><p><strong>Conclusions: </strong>These data suggest that the employed ERAS protocol significantly enhances recovery trajectories and the need for analgesics in patients undergoing lumbar spinal fusion.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine learning model and a web application for predicting neurological outcome at hospital discharge in spinal cord injury patients.","authors":"Kyota Kitagawa, Satoshi Maki, Takeo Furuya, Yuki Shiratani, Yuki Nagashima, Juntaro Maruyama, Yasunori Toki, Shuhei Iwata, Masahiro Inoue, Yasuhiro Shiga, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori","doi":"10.1016/j.spinee.2025.01.005","DOIUrl":"10.1016/j.spinee.2025.01.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Spinal cord injury (SCI) is a devastating condition with profound physical, psychological, and socioeconomic consequences. Despite advances in SCI treatment, accurately predicting functional recovery remains a significant challenge. Conventional prognostic methods often fall short in capturing the complex interplay of factors influencing SCI outcomes. There is an urgent demand for more precise and comprehensive prognostic tools that can guide clinical decision-making and improve patient care in SCI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to develop and validate a machine learning (ML) model for predicting American Spinal Injury Association (ASIA) Impairment Scale (AIS) at discharge in SCI patients. We also aim to convert this model into an open-access web application.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;This was a retrospective cohort study enrolling traumatic SCI patients from 1991 to 2015, analyzed in 2023. Data were obtained from the Japan Rehabilitation Database (JARD), a comprehensive nationwide database that includes SCI patients from specialized SCI centers and rehabilitation hospitals across Japan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients sample: &lt;/strong&gt;4,108 SCI cases from JARD were reviewed, excluding 405 cases, patients caused by nontraumatic injuries, patients who were graded as AIS E at admission, and patients without data of AIS at discharge, resulting in 3,703 cases being included in the study. Patient demographics and specific SCI injury characteristics at admission were utilized for model training and prediction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;Model performance was evaluated based on R&lt;sup&gt;2&lt;/sup&gt;, accuracy, and the weighted Kappa coefficient. Shapley additive explanations (SHAP) values highlighted significant features influencing the model's output.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The primary outcome was AIS at discharge, treated as a continuous variable (0-4) to capture the ordinal nature and clinical significance of potential misclassifications. Data preprocessing included multicollinearity removal, feature selection using the Boruta algorithm, and iterative imputation for missing data. The dataset was split using the hold-out method with a 7:3 ratio resulting in 2,592 cases for training and 1,111 cases for testing the regression model. A best performing model was defined as the highest R&lt;sup&gt;2&lt;/sup&gt; using PyCaret's automated model comparison. Final predictions of regression model were discretized to the original AIS categories for clinical interpretation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The Gradient Boosting Regressor (GBR) was identified as the optimal model. The GBR model showed an R² of 0.869, accuracy of 0.814, and weighted Kappa of 0.940. Eleven key variables, including AIS at admission, the day from injury to admission, and the motor score of L3, were identified as significant based on SHAP values. This model was then adapted into a web application via Streamlit.&lt;/p&gt;&lt;p&gt;&lt;strong","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk prediction model of pedicle screw loosening within 2 years after decompression and instrumented fusion surgery for degenerative lumbar disease.","authors":"Yen-Chun Huang, Po-Chun Liu, Hsi-Hsien Lin, Shih-Tien Wang, Yu-Ping Su, Po-Hsin Chou, Yu-Cheng Yao","doi":"10.1016/j.spinee.2025.01.033","DOIUrl":"10.1016/j.spinee.2025.01.033","url":null,"abstract":"<p><strong>Background context: </strong>Pedicle screw loosening (PSL) after spinal fusion surgery is one of the most frequently reported complications and leads to poor clinical outcomes.</p><p><strong>Purpose: </strong>This study aimed to develop and validate a risk prediction model for PSL within 2 years in patients undergoing lumbar instrumented fusion surgery based on their risk profiles.</p><p><strong>Study design/setting: </strong>Retrospective, observational study.</p><p><strong>Patient sample: </strong>Patients who underwent lumbar instrumented fusion surgery at a single academic institution between May 2015 and February 2019.</p><p><strong>Outcome measures: </strong>Risk assessment of PSL and development of a rating score based on patient characteristics.</p><p><strong>Methods: </strong>The demographic profiles and radiographic parameters using computed tomography were obtained. These factors were analyzed to determine possible risk factors related to postoperative PSL after 2 years. A scoring system was developed using these independent risk factors and validated using prospectively collected data from another center between May 2019 and December 2021.</p><p><strong>Results: </strong>The occurrence of PSL within 2 years postoperation was 12.7% (40/315). PSL was significantly predicted by smoking, low Hounsfield units (HU) of the pedicle tract at the index level (P), and a low psoas-lumbar vertebral index (PLVI). The risk of PSL according to the categories of the risk score was 1.1% for those with a score of 0-1, 15.1% for a score of 2-3, and 61.5% for a score of 4-6. In validation, this model demonstrated both good discrimination and calibration results. The area under the curve was 0.887 (95% CI 0.830-0.938) for the derivation cohort and 0.835 (95% CI 0.738-0.918) for the external validation cohort.</p><p><strong>Conclusions: </strong>This PSL risk score, including smoking, Index P HU, and PLVI, is a novel approach to predict PSL 2 years postsurgery. This approach highlights the role of factors associated with osteoporosis and sarcopenia in the development of PSL and could aid in preoperative decision-making and surgical planning.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the best strategy for C3 in open-door laminoplasty: laminectomy versus laminoplasty-a systematic review and meta-analysis.","authors":"Chun-Ru Lin, Sung Huang Laurent Tsai, Po-An Tsai, Yi-Jun Chen, Ming-Hao Chen, Sz-An Tsai, Lin-Sheng Hsu, Kuo-Hao Lee, Zhi Yi Lee, Fu-Cheng Kao, Ming-Kai Hsieh, Tsung-Ting Tsai, Po-Liang Lai, Tsai-Sheng Fu, Chi-Chien Niu, Ping-Yeh Chiu","doi":"10.1016/j.spinee.2025.01.034","DOIUrl":"10.1016/j.spinee.2025.01.034","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional open-door laminoplasty is commonly used to treat multilevel cervical disorders but often leads to complications such as loss of cervical lordosis, limited neck motion, and axial symptoms. These issues stem from the extensive disruption of musculature and structural alterations involved in conventional methods. To address these shortcomings, the modified open-door laminoplasty with C3 laminectomy technique has been developed as a modification of conventional open-door laminoplasty, with the aims to preserve the semispinalis cervicis muscle attached to the C2 spinous process, potentially improving postoperative outcomes by maintaining muscle integrity and stability of the cervical spine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study seeks to evaluate the clinical benefits of modified open-door laminoplasty with C3 laminectomy in comparison to conventional open-door laminoplasty approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design/setting: &lt;/strong&gt;Patient Sample: patients undergoing open-door laminoplasty OUTCOME MEASURES: The outcome measures assessed were categoried into self-report Measure including pain indices, physiologic measures including complications, and functional measures including operative time, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scores, length of hospital stay, and cervical range of motion (ROM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a comprehensive search across multiple databases, including PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Library, to identify randomized controlled trials (RCTs), cohort studies, and case-control studies that compare the clinical outcomes of conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy. Statistical analyses were performed using RevMan software to evaluate the differences between the 2 surgical techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our analysis included 11 studies encompassing 873 participants. The meta-analysis revealed no significant differences between patients undergoing conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy regarding operation time (mean difference, MD: 5.08, 95% confidence interval, CI: -3.04 to 13.21), length of hospital stay (MD: -0.33, 95% CI: -1.43 to 0.77), JOA scores (MD: 0.18, 95% CI: -0.03 to 0.40), NDI scores (MD: -0.14, 95% CI: -4.00 to 3.72), and complication rates (risk difference, RD: 0.01, 95% CI: -0.03 to 0.04). However, participants in the group that underwent modified open-door laminoplasty with C3 laminectomy exhibited a significantly greater range of motion (MD: 4.13, 95% CI: 0.07 to 7.20) and lower postoperative pain scores (standard mean difference, SMD: -0.57, 95% CI: -1.05 to -0.10).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study suggests that modified open-door laminoplasty with C3 laminectomy improves range of motion and reduces pain compared to conventional open-door laminoplasty, with no di","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single versus multiple fraction stereotactic spine radiosurgery for spinal metastases: a prospective randomized phase II trial.","authors":"Shih-Fan Lai, Yi-Lun Chen, Fu-Ren Xiao, Ya-Fang Chen, Szu-Huai Lu, Feng-Ming Hsu","doi":"10.1016/j.spinee.2025.01.019","DOIUrl":"10.1016/j.spinee.2025.01.019","url":null,"abstract":"<p><strong>Background context: </strong>Stereotactic spine radiosurgery (SSRS) shows potentials of better tumor and pain control for limited spinal metastases. However, the optimal schedule of SSRS is not well established and has never been investigated in a prospective randomized trial.</p><p><strong>Purpose: </strong>To compare 2 SSRS schedules to determine which results in the lowest rate of grade 3 or higher protocol-specified adverse events at 4 months.</p><p><strong>Study design: </strong>A prospective randomized phase II trial.</p><p><strong>Patient sample: </strong>Patients with biopsy-proven nonhematogenous malignancy and limited unirradiated spine metastases not requiring upfront spine surgery were eligible. Between November 2015 and April 2019, 69 patients were randomly assigned, yielding a total cohort of 63 analyzable patients with 79 treated spinal segments.</p><p><strong>Outcome measures: </strong>Primary outcomes were the 4-month grade 3 or higher adverse events determined by the Common Toxicity Criteria for Adverse Events version 4.0 (CTCAE) definitely, probably, or possibly related to single fraction or multiple fractions spine SSRS.</p><p><strong>Methods: </strong>All patients at a single tertiary medical center who had radiographic evidence of limited spine metastases not requiring upfront spinal surgery were randomized to receive 16 Gy in SF or 24 Gy in 3 fractions. A post-hoc analysis was performed to assess the cumulative incidences and prognostic factors of local progression (LP) and vertebral compression fracture (VCF) by the Fine and Gray competing risk model.</p><p><strong>Results: </strong>Sixty-three patients (29 with 38 spinal segments in the SF arm and 34 with 41 spinal segments in the MF arm) were analyzed. Median follow-up was 16.6 months. At 4 months, none of the patients in the SF arm and 1 patient in the MF arm experienced protocol-specified grade 3 or higher toxicity. The 1-year cumulative incidence of LP was 2.6% for the SF arm and 4.9% for the MF arm, respectively. The 1-year cumulative incidence of VCF was 7.9% and 10.1% for the SF arm and the MF arm, respectively.</p><p><strong>Conclusions: </strong>Both single-fraction and multifraction SSRS are safe. There was no difference in cumulative incidence of LP or VCF between 2 dose-fractionation schedules. Single-fraction SSRS is more efficient and provides the most acceptable outcome profile for all assessed endpoints.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and surgical characteristic of atlantoaxial reduction and fixation for patients with syringomyelia caused by atlantoaxial dislocation: retrospective study of 101 cases.","authors":"Ben Wang, Ruomu Qu, Chao Wang","doi":"10.1016/j.spinee.2025.01.025","DOIUrl":"10.1016/j.spinee.2025.01.025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background context: &lt;/strong&gt;Atlantoaxial dislocation (AAD) is a relatively rare condition at the craniovertebral junction. In a minority of cases, AAD may coexist with syringomyelia. There is currently a lack of large-scale case reports investigating the specific clinical and surgical characteristics of syringomyelia associated with AAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aimed to evaluate the treatment efficacy of surgical reduction and fixation for patients with syringomyelia caused by AAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patient sample: &lt;/strong&gt;Patients with syringomyelia and AAD underwent surgery performed by single surgeon between 2006.1 and 2021.12.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was the reduction condition of syringomyelia evaluated on the follow-up MRI, classified as completely recovered, reduced and unimproved. The secondary outcome was recovery of symptoms, which were classified as improved (symptoms improved, with or without remaining other symptoms) or unimproved (no change or worsening of preoperative symptoms).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 120 cases with syringomyelia and atlantoaxial instability who underwent atlantoaxial reduction and fixation surgery by single surgeon were reviewed. Out of these, 101 patients with a minimum follow-up of 6 months were included in the study. The patients' demographics, preoperative symptoms, length of syringomyelia, characteristics of craniocervical malformation, and the presence of basilar invagination (BI) and Chiari malformation were collected. Preoperative and follow-up clivus axial angle (CAA) was measured and CAA reduction angle was calculated by the postoperative CAA minus preoperative CAA. Improvement of symptoms and reduction of syringomyelia were evaluated at follow-up. Ordinal logistic regression and additional subgroup analysis were conducted to identify potential factors affecting the reduction of syringomyelia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 38 males and 63 females were included in the study, with a mean age of 36.9±12.4 years old. All patients presented with assimilation of atlas, and 53 patients had congenital C2-3 fusion. Among the patients, 100 patients had concomitant type A BI, and 97 had Chiari malformation. Most patients (94) exhibited myelopathy symptoms, 40 people had cranial nerve symptoms, and 20 patients experienced cerebellar symptoms. Sixty patients underwent traction, reduction and posterior C0-2 fixation surgery, while 41 patients received traction, transoral release and reduction, and posterior C0-2 fixation surgery. The average follow-up duration was 21.6 months. After surgery, all cerebellar symptoms and cranial nerve symptoms were alleviated. Eighty (85.1%) patients showed significantly improved myelopathy symptoms. Sixty-three patients showed completely recovered syringomyelia, 30 had reduced syringomyelia and 8 had unimproved syringomyelia. Ordina","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of adults with osteoporotic vertebral compression fractures.","authors":"Charles H Cho, Steven W Hwang, Daniel J Mazanec, John E O'Toole, William C Watters, Thiru M Annaswamy, Allan L Brook, David S Cheng, Sean D Christie, Zachary A Cupler, Dennis E Enix, Marjorie Eskay-Auerbach, Justin M Goehl, G Alexander Jones, Piyush Kalakoti, Manish K Kasliwal, Niranjan U Kavadi, Cumhur Kilincer, Justin M Lantz, Gazanfar Rahmathulla, Tom Reinsel, K Aaron Shaw, Ahmed Shawky Abdelgawaad, Amy M Skuteris, Jeffrey A Stone, Andrea L Strayer, Andrew N Vo","doi":"10.1016/j.spinee.2025.01.016","DOIUrl":"https://doi.org/10.1016/j.spinee.2025.01.016","url":null,"abstract":"<p><strong>Background context: </strong>The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adults with Osteoporotic Vertebral Compression Fractures features evidence-based recommendations for diagnosing and treating adult patients with osteoporotic vertebral compression fractures. The guideline is intended to reflect contemporary treatment concepts for osteoporotic vertebral compression fractures as reflected in the highest quality clinical literature available on this subject as of September 2020.</p><p><strong>Purpose: </strong>The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with osteoporotic vertebral compression fractures. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.</p><p><strong>Study design: </strong>This is a guideline summary review.</p><p><strong>Methods: </strong>This guideline is the product of NASS' Clinical Practice Guidelines Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with a medical librarian. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors.</p><p><strong>Results: </strong>Twenty-nine clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.</p><p><strong>Conclusions: </strong>The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with osteoporotic vertebral compression fractures. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at http://www.spine.org/guidelines.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The biomechanical impact of cement volume and filling pattern for augmented pedicle screws using various density testing blocks.","authors":"Ming-Kai Hsieh, Weng-Pin Chen, De-Mei Lee, Yun-Da Li, Fu-Cheng Kao, Hao-Hsin Chiang, Tsung-Ting Tsai, Tsai-Sheng Fu, Po-Liang Lai, Ching-Lung Tai","doi":"10.1016/j.spinee.2025.01.018","DOIUrl":"10.1016/j.spinee.2025.01.018","url":null,"abstract":"<p><strong>Background context: </strong>Patients with osteoporosis experience a higher risk of pedicle screw loosening and failure, making PMMA bone cement augmentation a common recommendation to increase stability. However, there is ongoing debate about the ideal cement volume, filling pattern, and measurable increase in stability that cement provides.</p><p><strong>Purpose: </strong>This aim of this study is to clarify the impact of cement volume and filling pattern on the stability of pedicle screws in synthetic bone blocks of varying density.</p><p><strong>Study design: </strong>We examined the effects of different volumes of PMMA cement on screw stability by using synthetic bone blocks with densities of 7.5 pcf, 15 pcf, and 30 pcf to simulate human vertebral cancellous bone with osteoporosis, osteopenia, and normal bone density. Two filling patterns were compared: a tip cement cloud and a surrounding cement cloud.</p><p><strong>Methods: </strong>We tested solid screws, cannulated screws without side holes, and cannulated screws with 4 side holes. Cement volumes of 2 cc, 3 cc, and 4 cc were injected, and the pullout strength was measured using an Instron testing machine. The samples were categorized into the control (no cement) group, S group (solid screws with prefilling), C1 group (cannulated screws without side holes), and C5 group (cannulated screws with 4 side holes). Among these, the C1 group exhibited a cement cloud at the tip, while the S and C5 groups showed a surrounding cement cloud.</p><p><strong>Results: </strong>Adding an extra 1 cc of cement (from 2 cc to 3 cc, or 3 cc to 4 cc) significantly increased the pullout strength by 10% in 7.5 pcf bone, 47% in 15 pcf bone, and 34% in 30 pcf bone and doubling the cement volume resulted in even greater increases. Regardless of the injected volume, cement augmentation substantially increased the pullout strength in osteoporotic bone compared with noncemented screws in osteopenic bone. For a given cement volume, the anchorage power was greater for the surrounding cement cloud pattern than for the tip cement cloud pattern.</p><p><strong>Conclusion: </strong>Although the addition of more cement increases the pullout strength, excessive augmentation in osteoporotic bone is unnecessary. The filling pattern is crucial; a larger contact area in the surrounding cement cloud enhances screw stability more effectively than the tip cement cloud does.</p><p><strong>Clinical significance: </strong>While adding more cement increases pullout strength, excessive augmentation in osteoporotic bone is unnecessary. The filling pattern rather than the screw design is a crucial determinant of screw stability.</p>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}